Saturday, November 28, 2015

Kentucky's expansion of the federal-state Medciaid program under federal health reform has not produced the jobs outgoing Gov. Steve Beshear says it has, Chris Otts reports for WDRB-TV in Louisville.

Beshear often says the expansion has added 12,000 health-care jobs, but he cites a state-funded study, not actual numbers reported by federal agencies, which are lower. "Monthly government data show Kentucky’s 'health care and social
assistance' sector has picked up – gaining nearly 10,000 jobs since the
Medicaid expansion started in January 2014 through October 2015," Otts writes. "But
that’s still short of the 15,509 jobs predicted by the model in 2015."

The 12,000 number is a projection generated by an economic model that is too simplistic for such a complicated move as Medicaid expansion, a leading University of Kentucky economist told Otts. “Which one would you believe?” Ken Troske asked. “I know which one I’d believe.”

The figures cited by Otts come from the federal Bureau of Labor Statistics, which reports jobs figures monthly, to the nearest 100. Its data show that when "social assistance" is removed from the health jobs category, the state has gained 6,800 jobs since January 2014. Almost all of that gain had been in ambulatory-care facilities, such as clinics, and residential facilities such as nursing homes.

Hospitals have 1,200 more jobs than they had in January 2014 but 200 less than December 2013, the month before the expansion began. Hospitals have said generally that they have been helped by the expansion, but hurt by another aspect of federal health reform -- cuts in Medicare payments -- and the Medicaid managed-care system that the state began four years ago.

Hospitals' poorer fortunes are illustrated by two charts prepared by University of Louisville economist Paul Coomes, one using BLS data that show hospitals losing jobs while other heath-care providers gained after the expansion, and recent, slight reversal of both trends. The other, using federal Bureau of Economic Analysis data, show how Medicare payments to Kentucky have remained relatively flat while Medicaid payments jumped after the expansion (labeled ACA).

Friday, November 27, 2015

University of Kentucky Vice President for Research Lisa Cassis's motivation to conduct meaningful cardiovascular research comes from having watched her father battle heart disease for nearly 30 years, a UK news release and video say.

“You don’t go into it for the money, you go into it because you want to help people,” Cassis said in the latest edition of "See discovery: The People Behind Our Research," a UK video series that highlights the stories of the university's researchers and what motivates them.

Cassis's father suffered his first heart attack at age 51, went through three open heart surgeries, and was able to live until age 80 by managing his diet. However, Cassis says his lipid problems kept coming back no matter what he did.

“I wanted to know why we aren’t able to help someone like him,” she said.

With more than 26 years at UK, Cassis has made many important discoveries in cardiovascular research, including a link between obesity and health problems like high blood pressure. More recently, she is studying sex chromosomes and their role in aneurysms, which is an enlargement of an artery caused by a weakening of the artery wall.

“Females are less likely to get aneurysms than men, and I’m trying to figure out why that is,” she said.

Thus far, Cassis's findings suggest that the introduction of male sex chromosomes in biological females could raise the risk of aneurysm, which she said may have a broader impact than she initially considered.

“We’ve become more aware in this country of gender and gender identity,” said Cassis. “From my perspective, as a cardiovascular researcher, the process of seeking one’s gender is taking certain types of sex hormones to promote the outcome that you would like for that gender. My concern is how that therapy will influence that person’s cardiovascular health.”

Cassis said she just wants to improve lives by doing what she loves most.

“I love trying to come up with a question and design an approach to tackle the question,” she said.

Cassis earned a bachelor's degree in pharmacy and a Ph.D. in pharmacology from West Virginia University. She joined UK in 1988, and is a faculty member in the Department of Pharmacology and Nutritional Sciences, the Saha Cardiovascular Research Center, the Graduate Center for Toxicology, the Barnstable Brown Diabetes and Obesity Center, and the College of Pharmacy.

Research within the Cassis laboratory has been continuously supported by grants from the National Institutes of Health, contributing to more than 130 scholarly publications. She has mentored many scientists, been the recipient of national and local research awards, and served for 10 years as program director of an NIH Training Grant in Nutritional Sciences.

Wednesday, November 25, 2015

Many consumers of health insurance under the Patient Protection and Affordable Care Act are finding that it's not as affordable as the name implies -- not because of the premiums, but due to the "sky-high" deductibles that leave many feeling like they don't have health insurance at all, Robert Pear writes for The New York Times.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” David Reines, a former New Jersey hardware salesman with chronic knee pain, told Pear. “We have insurance, but can’t afford to use it.”

Pear reports, "In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found." The lower the premiums, the higher the deductibles.

Kentuckians also struggle with high deductibles, based on a look at plans offered on Kynect, Kentucky's health insurance marketplace. Kentucky Health News examined what it would cost a one-parent, one-child family in Scott County.

The least expensive premium for this family on Kynect is the CareSource "bronze" plan at $254 per month, but this plan also has the highest deductibles at $6,650 per person and $13,300 per group.

The lowest deductible for this family is the Humana "platinum" plan at $500 per person and $1,000 per group, but this plan's premium was also one of the most expensive at $532.98 per month.

Two steps below the platinum plan are the "silver" plans, which are the most popular by far on the Obamacare exchanges. Deductibles for the silver plans available to our sample family ranged from $2,000 to $3,700 per person and $4,000 to $7,500 per group.

Deductibles for the bronze plans, which have the lowest premiums, ranged from $4,400 to $6,650 per person and $8.800 to $13,300 per group.

Other costs to consider when looking at the affordability of a plan are its co-payments, co-insurance and out-of-pocket maximums.

"Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game," Pear writes.

While the shift to cost-sharing through higher deductibles has become the norm, an analysis by the Kaiser Family Foundation found that fewer than half of all households above the poverty level have enough assets to cover an out-of-pocket maximum of $3,000 to $6,000, which is considered mid-range. The highest out-of-pocket maximum for 2016, as set by the health-reform law, is $6,850, according to Kaiser Health News.

While the report from HHS said, "Eight out of 10 returning consumers will be able to buy a plan with premiums less than $100 a month after tax credits, and about seven out of 10 will have a plan available for less than $75 a month," several consumers complained to Pear that the high deductibles make the plans unaffordable.

“Our deductible is so high, we practically pay for all of our medical expenses out of pocket,” said Wendy Kaplan, 50, of Evanston, Ill., whose family of four pays premiums of $1,200 a month, with an annual deductible of $12,700, “So our policy is really there for emergencies only, and basic wellness appointments.”

There are mitigating factors, Pear reports, health officials and insurance counselors cite several. All plans must cover preventive services without a deductible or co-payment; some plans help pay for some items before patients meet their deductible; there is an overall limit on out-of-pocket costs; and there are discounts available for those with particularly low incomes.

And for those who say their deductibles are too high, Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, told Pear, “Everyone should come back to the marketplace and shop. You may get a better deal.”

But Pear writes that the deductibles are so high they may be scaring away some consumers, especially the young, healthy consumers that would help bring the premiums down for everyone.

Alexis C. Phillips, 29, of Houston, is one of those who told Pear, “The deductibles are ridiculously high. I will never be able to go over the deductible unless something catastrophic happened to me. I’m better off not purchasing that insurance and saving the money in case something bad happens.”

The penalty for not having health insurance in 2016 is $695 or 2.5 percent of household income, whichever is greater.

Tuesday, November 24, 2015

Safety is part of health, broadly defined, and Kentucky's 2014 workplace injury and illness rate is the lowest it has ever been since the U.S. Bureau of Labor Statistics began recording the data in 1996, according to a Kentucky Labor Cabinet news release. However, it remains well above the national average.

Kentucky had 3.8 injuries or illnesses per 100 equivalent full-time workers, down from 4.2 percent in 2012. The national average is 3.2 percent In 2014, Kentucky reported 15,650 non-fatal workplace injuries and illnesses involving days away from work, job transfer or restricted duty. This was down from 16,660 in 2013 and 16,620 in 2012.

The two areas with the highest injury and illness rates in 2013 were the machine shop industry (12.5 percent) and the wood container and manufacturing industry (11.5). The Labor Cabinet said it worked directly with these industries to eliminate hazards and improve health and their rates have since fallen to 8.5 and 8.8 percent, respectively.

“Simply put, workers are safer now in Kentucky than ever before,” Kentucky Labor Secretary Larry L. Roberts said in the release.“This is a work in progress, however, because safety doesn’t just happen by accident. Programs such as the Labor Cabinet’s free consultation surveys, partnerships with employers and targeted enforcement of certain higher-risk industries are crucial to the continued decline in workplace incidents.”

Robert Henry, a Lexington Veterans Affairs Medical Center dentist, is retiring from his administrative duties at the Lexington Mission Dental Clinic on South Martin Luther King Boulevard, but plans to continue there as a volunteer, Cheryl Truman reports for the Lexington Herald-Leader.

Henry, originally from Jefferson County, is a founding board member of the clinic, which opened in 2006. Most of the clinic's services are free to those without dental insurance, but it does charge for partial fixtures and dentures. The clinic stays busy, with volunteers finishing around 9 p.m. most nights, but closer to midnight when they are busy, Ruta Valinskaite, the clinic's manager, told Truman.

“We realized there was a need for such dental care in Lexington and nobody to provide it,” he told Truman.

The clinic was formed by members of Calvary Baptist and Faith Lutheran churches, of which he and his family are members. Good Shepherd Episcopal, Maxwell Street Presbyterian and First Presbyterian churches and other volunteer organizations have since joined the clinic, Truman reports.

Henry, 60, came to the University of Kentucky as an undergraduate hoping to become a basketball walk-on in the era of Adolph Rupp, but was trimmed in the final cut, Truman reports. Instead, his other love, science, led him to dental school. He also has a master's degree in public health.

He served as a colonel in the Army Reserve and came to work at the VA Medical Center in Lexington in 1985. He has also been an associate professor at UK's dental school, where he and another faculty member Judy Skelton, helped to created a Community Based Public Health Dentistry elective for dental students. "The course became the most popular elective and is so in demand that a lottery is held for the right to volunteer," Truman writes.

Henry told Truman that his professional interest led him to UK and the VA, but it was his religious faith that led him to the mission dental clinic. Before volunteering at the current mission clinic, he volunteered at Nathaniel United Methodist Mission.

Women who suffer from heart disease often have different symptoms than men and high blood pressure is often called the silent killer because you can have it without any other symptoms; these are the messages two Kentucky women who have suffered from these conditions want to share to help others, Joyce West reports for Kentucky Educational Television.

Heart disease is the No. 1 killer of both men and women in the U.S. While both men and women can experience chest pressure that many say feels like an elephant sitting on the chest, women often have symptoms that they don't connect to heart disease, such as extreme fatigue, irregular back discomfort, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness, jaw pain, shortness of breath and nausea, according to the American Heart Association.

“And by the time they get to the physician or the hospital, they are actually sicker than their male counterparts are,” Dr. Melissa Walton-Shirley, a Glasgow cardiologist, told West.

Family history, high blood pressure, high cholesterol and diabetes are all risk factors for heart disease. In addition certain lifestyle factors can put people at risk, such as an unhealthy diet, high in saturated fat, trans fat, cholesterol, and sodium; physical inactivity; obesity; too much alcohol (more than one drink a day for women, more than two for men); and tobacco use, West reports.

Missy Norris, a grandmother and longtime employee of Brown-Forman Corp. in Louisville, had a family history of heart disease, but didn't think she was at risk because she was physically active, a nonsmoker and of normal weight, West reports.
.
“My dad had three heart attacks, a stroke, and also had open heart surgery. My mother had a heart attack and open heart surgery–both in their 60s for the open heart surgery,” she said.

But Norris had symptoms of heart disease that she didn’t recognize: fatigue, occasional pain in her heart and chest, and pain in her upper arms, which she said she "never associated that with (the) heart. Not ever.” These symptoms got worse over time, but she didn't seek medical help until she started having trouble breathing in extreme temperatures.

“There was so much going on in my life with work. ... I self-diagnosed: It was just, I’m tired. It will get better tomorrow, I just need more rest," she told West.

Norris's doctor immediately did an EKG, which led to a procedure that determined she had four blockages. “We fixed three of them that day, and we saved the other one because he didn’t think I could handle it all at once," she told West. "He told me ... I was probably about a week away from having a massive heart attack, and I probably wouldn’t have survived,”

Nikki McCubbins, a Louisville mother of three, who told West that her "mother's brothers and sisters generally don't get past the age of about 62 before they have a fatal heart attack and pass away," found out at a postpartum checkup that she had high blood pressure.

“I had no idea I had high blood pressure, no idea,” she said. She now takes medication,exercises, maintains a healthy diet and works to reduce her stress to decrease her blood pressure.

Both Norris and McCubbins have participated in the American Heart Association's Louisville Go Red for Women Luncheon, held to support the fight against heart disease in women, and they want to help others learn about heart disease and women.

“I would tell women to go to the doctor, get your numbers. If your numbers are high, make some changes,” McCubbins told West. “And the changes are simple, you know. Get a little exercise in. Try to minimize stress. Just try to live a healthy life as much as possible.”

Norris's advice: “When your body’s telling you something, take care of it, because I didn’t. And I had no idea that I was that close to disaster."

The 2015 Lexington Red For Women Luncheon will be held Friday, Dec. 4, from 9 a.m. to 1 p.m. at the Lexington Center's Heritage Hall, 400 W. Vine St. Tickets are $100 each or $1,000 for a table of 10.

The Go Red for Women effort focuses on three areas: heightening awareness of the issue, creating a passionate call-to-action and generating funds to support education and research.

Monday, November 23, 2015

As uncomfortable as it may be to talk about safe sex with a teenager, it can have a positive impact, especially for girls, according to a new study published in the Pediatric Journal of the American Medical Association.

"Sexual communication with parents, particularly mothers, plays a small protective role in safer sex behavior among adolescents; this protective effect is more pronounced for girls than boys," says the study report.

The study examined the link between parent-adolescent communication about sex and safer sex practices among youth. It analyzed 52 studies on the topic from more than 30 years of data and included more than 25,000 adolescents.

"Our results confirm that, across more than 50 studies, parent-adolescent sexual communication is positively associated with adolescents' use of contraceptives and condoms regardless of communication topic or format," says the report.

It is a message many Kentucky teens need to hear.

According to the 2013 High School Youth Risk Behavior Survey, 44.7 percent of Kentucky's students have had sex at least once, and almost one-third (31.7 percent) of them are sexually active. Almost half of them (46.9 percent) did not use a condom during their last sexual intercourse and 15.1 percent of them did not use any method to prevent pregnancy. And while Kentucky's teen pregnancy rate is at an all time low of 39.5 per 1,000 girls between 15 and 19, it's still much higher than the national rate of 26.6 per 1,000, according to the federal Centers for Disease Control and Prevention.

In addition, young people between the ages of 15 and 24 account for about half of all new cases of sexually transmitted diseases in the U.S. each year, says the CDC.

Despite the risk of disease and pregnancy, nearly one-fourth of youth report that they have not discussed sexual topics with their parents, and even fewer report they have meaningful, open conversations with them about this subject, the study found.

The study attributes this poor communication to parental embarrassment, parents' lack of accurate knowledge of the subject, and poor self-efficacy. It suggest physicians and other health care professionals should encourage these discussions and encourages parents to seek formal instruction on how to discuss safe sex practices with their children.

CBS News asked several experts for some do's and dont's to help parents talk about sex with their teens.

Dr. Anna-Barbara Moscicki, chief of Adolescent and Young Adult Medicine and professor of pediatrics at Mattel Children's Hospital UCLA, told CBS that parents should start talking about sex early "so it's never awkward." She said parents should answer all their children's questions about sex, but "keep it age-appropriate." She reassured parents that "talking about sex does not make your kid want to have sex."

Moscicki also advised that you should never confront a teen with questions such as, "Are you having sex? Are you using condoms?" Instead, she says you should be a resource and ask, "Do you know where to get condoms or get birth control?"

Dr. Leslie Walker, division chief of adolescent medicine at Seattle Children's Hospital, told CBS that "parents need to be informed before they talk with their kids about sex," including accurate information about modern and efficient methods of birth control than weren't available when they were younger.

She said parents should not be afraid to share their family values and that talking about safe sex should not be a "one time chat," but instead an ongoing conversation.

Walker also said that parents need to push through the awkwardness of the conversation and not be judgmental or punitive, which she said will allow teens to know they can rely on their parents for help if something were to happen, like an unplanned pregnancy or a sexual assault.

"Don't shut kids down," Walker told CBS. "Don't shut down the lines of communication, like saying, 'If you ever do this, then you're out of the house.'"

Both experts agreed that parents shouldn't overshare. Walker said, "Kids don't want to know about their parents' sex life, or what happened to you when you were a teen." But they might if you lecture them about their behavior and make them defensive.

"Health Matters," a medical radio show on WMKY in Morehead, recently aired its 600th edition, according to a University of Kentucky news release.

Dr. Anthony Weaver and Rick Phillips, manager of communications infrastructure at UK, co-host the show, which debuted in 2003.

"It's my golf," said Weaver, a general internist and associate dean of the Rural Physician Leadership Program at UK's College of Medicine, which is based at a satellite campus in Morehead. "I have a passion for teaching and felt like I had lost opportunities to teach in my practice. This and my love for medical research led to the radio show."

Weaver and Phillips restructured the program in 2003 to be educational, engaging and entertaining, breaking away from the typical physician call-in show of that time, the release reports.

"One of Weaver's favorite shows, "A Musical Journey to Your Anus," won the 2013 National Media Award from the American Society of Colon and Rectal Surgeons for excellence in communicating a better understanding of colon and rectal disease. It featured such catchy tunes as "Oops the Colon's Fragile; It gets Diverticulosis" and "Under the Cecum," the release says.

"Guests have included Kentucky Gov. Ernie Fletcher, former UK President Lee Todd, MSU President Wayne Andrews and 'Kentucky Joe' from the reality show 'Survivor.' Also featured have been UK's vice president for health affairs and the deans of the University Louisville School of Medicine and the University of Pikeville's Kentucky College of Osteopathic Medicine," the release reports.

"The show could not have reached our 600th milestone without the generous support of the Northeast Kentucky Area Health Education Center and the guidance of Morehead State Public Radio Station manager Paul Hitchcock and news and information director Chuck Mraz," Weaver said.

Sunday, November 22, 2015

The fate of the Patient Protection and Affordable Care Act may depend on how long two major insurance companies "are willing to wait before starting to make money off it," Zachary Tracer reports for Bloomberg News.

Anthem Inc. and Aetna Inc. "are on the hot seat now that UnitedHealth Group Inc. appears likely to linger as a seller on the Affordable Care Act's government-run markets," Tracer writes. "UnitedHealth, the U.S.'s leading health-care insurer, said Thursday that if it can't turn a profit, in 2017 it may quit the health-plan marketplaces," such as Kentucky's Kynect.

United and Aetna recently started offering policies on Kynect for the first time, United statewide and Aetna in only 10 counties. Anthem has been on the two-year-old exchange from the start. Across the nation, "Aetna has said it's losing money while Anthem has said it's making less than it would like," Tracer reports.

"It looks like it's more of a United issue," Decision Resources Group analyst Bill Melville told Tracer. "It's a wake-up call that there's been some pretty tough headwinds." Wells Fargo analyst Peter Costa "said he expects Anthem and Aetna to lose money on the exchanges next year, potentially leading them to reconsider their posture."

Aetna, which is in the process of buying Louisville-based Humana Inc., has said it's willing to wait a few years for improvement in the exchange business.

"More than half of about 400,000 Kentuckians who gained Medicaid coverage under the federal law also known as Obamacare have jobs but did not have health insurance," Deborah Yetter reports for The Courier-Journal, calling that "a lesser-known fact of the Medicaid expansion implemented by outgoing Gov. Steve Beshear."

"The reality is that lots of workers can't get health insurance through
their employers," Jason Bailey, executive director of the Kentucky
Center for Economic Policy, a nonprofit research and policy organization
in Berea, told Yetter. "They have a job but they're not getting health insurance
through their job." The center says only 54 percent of Kentucky workers got employer-based health insurance in 2013.

In a report just after the Nov. 3 election, the center said that at least 73,800 of the 137,200 Kentuckians who gained Medicaid coverage in 2014,
the first year of expansion "were
employed but had annual incomes low enough to qualify for Medicaid," Yetter reports. "Restaurant and food service employees accounted for the highest number
of such workers, followed by people employed in construction, retail,
landscaping, child care, farming, cooking and cleaning, said the report,
based on U.S. Census data."

Supporters of the Medicaid expansion "say too many Kentuckians assume people who benefit from the Medicaid expansion aren't willing to work," Yetter writes, quoting Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of lobbying groups: "I
think there's a misconception about who is getting covered under
Medicaid. A majority of people
are hard-working folks whose jobs don't have health care."

Gov.-elect Matt Bevin made such references in his campaign. He says he wants a federal waiver to allow the state to require premiums, co-payments and/or deductibles from at least some Medicaid recipients, giving them "skin in the game." Bailey is concerned that cost-sharing would discourage people from getting the health care they need. "These people do have skin in the game," he said. "They're working. They're just not making enough to buy health insurance."

Dr. Rice Leach has announced that he will retire as Fayette County health commissioner, ending a remarkable public-health career that has included stints as state health commissioner and chief of staff to the surgeon general of the United States.

"I'm 75; I've been in this since 1964," Rice told Bill Bryant on Sunday's edition of "Newsmakers" on Lexington's WKYT-TV. He said he has been through a third round of chemotherapy for lymphoma, which is "not responding as nicely as I would like it to," so he will leave as soon as his successor is hired or he can't continue to work at the Lexington-Fayette County Health Department.

"Lymphoma is a concern, but hanging it up after 52 or 53 years, that's going to be an adjustment for this guy," he said. "The best job I ever had is the one I have now," because the work involves providing prevention and other health care directly to people.

Leach was state health commissioner from 1992 to 2004, after more than 26 years with the U.S. Public Health Service, mostly with the Indian Health Service. In his current job, he has been an outspoken advocate of voluntary needle-exchange programs authorized by the legislature this year to thwart the spread of disease by heroin addicts.

Leach said he expects to remain active in public health, perhaps through newspaper columns that are likely to reflect his outspoken nature. "It's a congenital asset, sometimes defect," he said with his typical chuckle.

Leach illustrated that in saying that the public-health system could use more money, but health care in general could be more efficient. "There's some slack in that system, if they can get relief from rules" that could reduce clerical work, he said.

And as usual, Leach had some advice for the public: "It's absolutely imperative that people get their flu shots" because so many people in the population are taking chemotherapy or other drugs that lower their resistance to infection.

His most general advice: "Exercise, do things in moderation, and protect yourself from infections. . . . The best thing you can do, if you're over 50, is make sure your cholesterol is under control, make sure your blood pressure is under control, and protect yourself from infection . . . . Wash your hands, for crying out loud!"

Saturday, November 21, 2015

The Kentucky College of Optometry, part of the University of Pikeville, has received preliminary accreditation, allowing it to recruit students for its first class next fall.

The Accreditation Council on Optometric Education notified the university of the approval. ACOE will review the school annually during its first three academic years, and a request for
full accreditation will be made by the university not less than
12 months prior to graduation of the program’s first class, the university said in a news release.

“We are the first school to receive such recognition under the new, more stringent accreditation standards, and in a record time of one year and three months from the time we initiated our self-study,” Founding Dean Andrew Buzzelli said in the release.

A recent state law allowing optometrists to perform selective laser and peri-ocular
surgical procedures will allow the college to bring
such treatments to medically under-served areas, the release said. "The approach to clinical care will also
be unique," it said. "The college of optometry is partnering with local federally
qualified health care centers and hospitals to create a new
patient-centered model for the education of eye care providers and
creating access to vision care for the citizens of Appalachia."

The college will be the 22nd in the nation and will admit 60 students per class, for a four-year total of 240. "With no
other colleges of optometry in Kentucky, West Virginia, Virginia, North
Carolina, South Carolina or Georgia, KYCO will be the most accessible
college of optometry in the Southeastern portion of the country," the release said.

It noted that Central Appalachia "has the highest incidences of severe
vision loss from other factors such as diabetes and hypertension," the release said, noting that Owsley County leads the nation with more than 18 percent.

UPike, as the university calls itself, also has a college of osteopathic medicine and a school of nursing.

Friday, November 20, 2015

Nursing homes and many other health care providers will be required to obtain national criminal background checks on new employees and others who provide direct one-on-one care to elderly residents or patients, under an emergency regulation outgoing Democratic Gov. Steve Beshear issued Friday.

Besides nursing homes, which have been the focus of concern about elder abuse, the regulation also applies to personal-care homes, intermediate care facilities, adult day health-care programs, assisted living communities, home health agencies, hospices, personal-services agencies, providers of home and community-based services, and staffing agencies, "including nursing pools that have contracts to provide staff to one or more of the listed employer types," a state news release said.

Only 7 percent of those providers are using a voluntary system to do national, fingerprint-supported background checks, Cabinet for Health and Family Services spokeswoman Beth Fisher told Kentucky Health News.

“Protecting the elderly and other individuals residing in these facilities is not only important – it is our duty as state leaders,” Beshear said in the release. “All too often, these vulnerable citizens become victims of the very individuals who are supposed to be caring for them. This regulation, based upon a federal law allowing these background checks, will ensure we are able to thoroughly track the history of anyone who has committed such an offense, whether it occurred in Kentucky or out of state, and ensure they will not be working at health care facilities in the commonwealth.”

State law requires only name-based, Kentucky-specific background checks, "creating a loophole that allowed applicants seeking employment in these long-term care and other settings to hide criminal actions committed in other states," the release said. "Meanwhile, the prevalence of alleged abuse or exploitation of seniors in these settings remained significant."

The release said that since May 2014, over 2,600 complaints have been filed against long-term care providers, almost 30 percent directly related to suspected abuse or exploitation of residents. Requiring fingerprint-supported background checks means that "applicants will not be able to hide criminal actions committed in other states," Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said in the release. "National background checks are a critical initiative that dramatically improve the ability of long-term care and other providers to timely and accurately research the backgrounds of potential employees, ruling out individuals with histories of violence, abuse or exploitation that occurred in other states."

The state has operated a fingerprint-supported vetting program since 2011, using federal grants. “This program . . . has now been fully tested by voluntary participants over the last 18 months, and the feedback has been overwhelmingly positive regarding its ease of use, cost effectiveness and speed,” CHFS Inspector General Maryellen Mynear said in the release. “Our office will assist providers as they apply for initial licensure or renew their existing license to ensure a smooth and timely transition to a national criminal background check program that meets the requirements of this regulation.”

The program usually returns results in 24 to 72 hours, compared to three or more weeks using the traditional, paper-based process, the release said. However, only 85 of the 1,267 providers who will be covered by the new rule use the voluntary program, CHFS spokeswoman Beth Fisher said.

Because the rule is in an emergency regulation, Republican Matt Bevin could revoke it after he becomes governor Dec. 8, but Beshear's news release quoted Republican state Sen. Tom Buford of Nicholasville as saying, “I commend Gov. Steve Beshear for this action to provide protections for our senior citizens.”

State Rep. Linda Belcher, D-Shepherdsville, said in the release, “I have been working on legislation to accomplish this for some time now and am very pleased Gov. Beshear has taken this step to further protect the elderly residents and patients.”

The release said the voluntary program "has performed more than 2,200 background checks and has screened out applicants who had been convicted of serious violent offenses in other states but had no criminal history in Kentucky." The program’s website, http://chfs.ky.gov/os/oig/kares, contains provider enrollment information, general information for both providers and the public, frequently asked questions and links to related programs and content. Additional information is available via email to KARES.Helpdesk@ky.gov or by calling 502-564-2159.

A Louisville urologist is the first in the nation to use ultrasound to treat prostate cancer, a procedure that recently received federal approval but still "has its critics as well as its fans," Darla Carter reports for The Courier-Journal.

"Dr. John Jurige, a longtime local urologist, is treating patients with
Sonablate, a device that uses high-intensity ultrasound waves to destroy
cancerous prostate tissue," Carter writes. "The outpatient procedure is typically for
men with stage 1 or 2 prostate cancer that hasn’t spread and who meet
certain other criteria, such as having a relatively small prostate."

Jurige said he has used the treatment on about 400 patients outside the U.S. in the last eight years, and those “who did, in fact, have early stage prostate cancer have done extremely
well,” he said.

"But some physicians say the high-intensity focused ultrasound (HIFU)
procedure isn't necessarily right for the men it's being pitched to
and that it's important for patients to consider all of their options
and to, perhaps, seek a second opinion," Carter reports. Dr. Jamie Messer, a urologic oncologist at Louisville's James Graham Brown Cancer Center, told her, “The patients that are really candidates for HIFU for prostate cancer are patients that may be best served with active surveillance,” or close monitoring.

“The type of prostate cancer that HIFU seems to be most effective for is
the type of prostate cancer that patients may live for decades with,
without any negative consequences, meaning no metastasis (spread) of
their cancer, no symptoms from their cancer,” Messer said. “This is the
patient we often refer to that will die with their prostate cancer, not
from their prostate cancer.”

Carter reports, "Patients turn to the $25,000 procedure not only to eradicate their
cancer but to try to avoid unwanted consequences, such as erectile
dysfunction and bladder-control issues, that people associate with
prostate cancer treatment." Her story includes quotes from satisfied patients.

Baptist Healthcare System is getting a $182,566 grant from the U.S. Department of Agriculture to install teleconferencing and telehealth equipment for five facilities in medically underserved areas in southeastern Kentucky.

The grants from USDA Rural Development's Distance Learning and Telemedicine program will held Knox County Hospital, Pineville Community Hospital, and Baptist Health Richmond as well as primary care clinics in Williamsburg and London, reaching approximately 5,000 people, Baptist Health said.

Thursday, November 19, 2015

Falls are the top cause of home injuries, sending over one
million Americans a year to an emergency department for treatment.

“Most people think of their home as a safe haven – not as a
likely spot for accidents. Conditions that you take for granted – a pile of
items to take upstairs now stacked in a corner, a cord snaked across the floor
to charge a cell phone – may be hazardous to your health,” Regene Collier of Baptist Health Home Care in Lexington said in a news release.

Collier suggests that you take a fresh look at your home environment and take these
easy steps to remove hazards:

·Create
clear, uncluttered pathways.

·Remove
throw rugs or install non-skid backing on them.

·Move
electrical cords out of walkways. Coil or tape cords next to walls to avoid
having to walk over or around them.

·Make
sure handrails on stairs are sturdy. Install handrails on both sides if
possible.

·Rearrange
items in your kitchen so that you can reach them easily.

·Place
a light near your bed where it is easy to reach.

·Install
lights on stairs and night lights in hallways.

·Use
grab bars in the tub or shower.

·Put
a non-slick mat or stick on strips in the floor of the tub or shower.

Collier said making these changes to your home or office will help to
reduce your risk of falling.

Wednesday, November 18, 2015

The American Medical Association is calling for a ban on advertising of prescription drugs to patients, saying "a growing proliferation of ads is driving demand for expensive
treatments despite the clinical effectiveness of less costly
alternatives."

The vote by the nation's leading organization for physicians also reflects “the role that marketing costs play in fueling escalating drug
prices,” AMA Board Chair-elect Patrice A. Harris said.
“Direct-to-consumer advertising also inflates demand for new and more
expensive drugs, even when these drugs may not be appropriate.”

An AMA news release said the U.S. and New Zealand are the only two nations that allow "direct-to-consumer advertising of prescription drugs.
Advertising dollars spent by drug makers have increased by 30 percent in
the last two years to $4.5 billion, according to the market research
firm Kantar Media."

The advertising ban was suggested as part of a policy package aimed at making prescription drugs more affordable. "The AMA will encourage actions by federal regulators to limit
anticompetitive behavior by pharmaceutical companies attempting to
reduce competition from generic manufacturers through manipulation of
patent protections and abuse of regulatory exclusivity incentives," it said. "The AMA will also monitor pharmaceutical company mergers and acquisitions, as well as the impact of such actions on drug prices."

Three professors at the University of Kentucky and one at Wake Forest University have received $6.4 million from the National Institute on Drug Abuse to keep developing "a promising new therapy for overdose and addiction closer to clinical trials," a UK news release reports.

“Dr. Zhan’s groundbreaking work in this field cannot be overstated,”
said Kelly M. Smith, interim dean of the UK College of Pharmacy. “There currently is no FDA-approved
treatment for cocaine overdose or cocaine addiction, and Dr. Zhan and
his research team are trying to change that. Developing such therapies
would be a major breakthrough for health care.”

Zhan's team designed and tested an enzyme that breaks down cocaine in the blood without producing harmful
byproducts. Now it will evaluate another enzyme "for its ability to neutralize cocaine in
the bloodstream using molecular modeling technology," the release said. Early results show it is more effective ans acts more quickly.

"We envision that this therapy could eventually become a viable treatment option for cocaine abuse," Zhan said in the release.

The bankrupt Clinton County Hospital in Albany is discussing a sale to the parent firm of the Bowling Green Medical Center, which already "owns several hospitals in south-central Kentucky," the Clinton County Newsreports.

The hospital said in a news release that it “asked CHC to evaluate operations at Clinton County
Hospital to determine the feasibility of Commonwealth Health Corporation
assuming ownership and operation of Clinton County Hospital.” It quoted hospital Administrator J.D. Mullins as saying, “In
an effort to help stabilize operations of our hospital and to have
access to the capital needed to support its ongoing mission in service
to the local community, Clinton County Hospital invited Commonwealth
Health Corporation to analyze our facility, services and financial
position and to meet with our local physicians. This
review is in its preliminary stage and no time frame was set for its
conclusion.”

The news reports, "The
only additional information Mullins would give was that the next step
in the process would see Commonwealth Health executives meeting with
local physicians who are on staff at the hospital."

The hospital went into Chapter 11 bankruptcy reorganization more than a year ago, after being unable to repay a $15 million U.S. Department of Agriculture loan that it received to expand and modernize the hospital in the county of 10,000 on the Tennessee border south of Lake Cumberland. The project was completed in 2008. The hospital has blamed its problems on federal budget cuts and changes in Medicare and Medicaid, which provide more than 80 percent of the hospital's revenue -- particularly the managed-care companies that oversee Medicaid.

USDA recently forgave more than half the $18 million in accumulated debt, leaving $8,465,000 still owed. Mullins said at the time that the settlement could make the hospital more attractive to a buyer.

Tuesday, November 17, 2015

With the end of his eight years as governor in clear view (his last day in office is Dec. 7), Steve Beshear put his work for Kentucky's health first in a list of broad accomplishments as the third person to serve two consecutive terms as the commonwealth's chief executive.

While Beshear's list said it was unranked, it mentioned health first in both a headline and the list of 13 successes. The health item was labeled "Reducing the number of Kentuckians without health
coverage from 20.4 percent to 9 percent (according
to a Gallup poll)." But it did not specifically mention the Patient Protection and Affordable Care Act, often called Obamacare, a set of health reforms that were controversial and perhaps politically damaging to Beshear and his fellow Democrats -- or his expansion of Medicaid with Obamacare money that will require a 5 percent state contribution in 2017. Beshear's health item read:

Taking advantage of the “big solution” offered by new
federal health programs,
Gov. Beshear helped bring health coverage to over half a million more
Kentuckians. The expansion of Medicaid eligibility and the creation of a
state-based health benefit exchange called Kynect (deemed the most successful
in the nation) have been enabling Kentuckians to access lifesaving preventive
care in record numbers and is already having an impact on some of Kentucky’s
most stubborn health problems, such as obesity, smoking, cancer and heart
disease, as shown by the year-end progress report of the Kyhealthnow
initiative. It also brought nearly $3 billion in direct payments to health
providers in the first 18 months of the reform, as the health industry created
thousands of jobs to provide that needed care. Kentucky moved to a Medicaid
managed-care system in November 2011, saving the state millions of dollars.

Hospitals and other health providers have generally welcomed Obamacare and its Medicaid money, but have complained long and loud about managed care, in which patients' coverage is administered by managed-care organizations, mainly subsidiaries of insurance companies, that get a flat fee per patient and make money on every expense they prevent.

Republican Gov.-elect Matt Bevin has said he will scale back the Medicaid expansion and dismantle Kynect. After the Nov. 3 election, Beshear urged him to keep both as they are; before the election, he made no special effort to raise the issue, except in his weekly video on Oct. 28, when he and First Lady Jane Beshear spoke about health, briefly mentioning the Medicaid expansion and federal health reform, and highlighting Kynect, the state health-insurance exchange. The video is at https://www.youtube.com/watch?v=Sf_f4hQUs68.

In another health-related item, Beshear's post-election release said one success of his administration was "fewer pill mills," or "unscrupulous pain clinics who couldn’t or wouldn’t meet new requirements that they be owned/managed by physicians." He cited his worked with the General Assembly to pass
a bill that also "reduced 'doctor shopping' by training doctors to
recognize abuse and improve their prescribing. Other bills focused on
methamphetamines, synthetic drugs and heroin," a narcotic that became much more popular after the pill mills closed.Beshear also cited "expansion of substance
abuse services and more emphasis on education and treatment" and his continuation of "the Recovery
Kentucky program, which helps Kentuckians overcome chronic substance abuse and
addiction, and move toward a life of sobriety and productivity."

"You probably have at least three kinds of painkillers in your bathroom medicine cabinet, but they're not all designed to treat the same types of discomfort," Erin Brodwin writes for Business Insider. "While some relievers are great at bringing down fevers, others contain the ingredients needed to reduce the kind of painful swelling linked with muscle soreness or arthritis. Depending on your medical history, and even what you've eaten or drank recently, there may be certain over-the-counter medications you should avoid altogether." BI offers this chart, which is limited to the treatment of pain; many of the medications listed can treat many other symptoms.

Cold and flu season is here, and the lack of a cure for the common cold has helped sustain much misinformation about it. Neda Frayha, an assistant dean at the University of Maryland School of Medicine, did a column for The Washington Post outlining five myths about the common cold:

1. Colds can be spread only if someone sneezes or coughs. Actually, direct contact
with a cold sufferer "is even more likely to make you sick,
whether or not they cough near you," Frayha writes. "Several major studies have shown
that hand-to-hand touch is the most common way to spread rhinovirus, the
family of viruses that causes most colds. One of these studies . . . also
demonstrated the importance of hand hygiene — it recommended applying a
liquid iodine solution to the fingers, though soap works well, too — in reducing the spread of the virus."

You
can get a cold from someone else's sneeze even if you aren't around. "Viruses can live on furniture, toys, phones and
other common household or office surfaces for several hours," Fyarha writes. "A study
in the American Journal of Epidemiology in 1982 showed that when young,
healthy adults touched either coffee-cup handles or plastic tiles that
had been contaminated with rhinovirus, and then touched their faces,
half of them came down with a cold. Fewer of them became sick if they
touched a plastic tile that had been sprayed with a disinfectant."

2. Hand-sanitizing gels are as effective as hand-washing to prevent the spread of the cold. "If given a choice between washing with soap and water or coating your
hands in a dollop of sanitizer," Frayha writes, "the old-fashioned soap-and-water
combination is the safer bet. Sanitizing gels don’t work well if your
hands are visibly dirty. And they must contain at least 60 percent alcohol to reduce the spread of diseases such as the cold, but some varieties at your local pharmacy contain significantly less."

3. Air travel increases your risk of catching a cold. "There is no evidence that air travel makes us any sicker than our normal working environments on the ground," Frayha writes. "A large study
published in the Journal of the American Medical Association in 2002
showed that traveling in a commercial aircraft with recirculated air did
not increase the risk of catching a cold compared with flying in a
plane that pumped in fresh air."

4. Colds cause fevers. Usually not in adults. "Fever is listed as a symptom of the common cold in television
commercials for over-the-counter remedies . . . and in young children, fever is common in most upper respiratory infections," Frayha writes, but in adults, "fever — defined as a temperature of 100.4 degrees Fahrenheit or higher — is actually very rare
in rhinovirus infections. It is much more common for a cold to cause a
sore throat, a stuffy and/or runny nose, sneezing and cough, but with a
normal body temperature. If you have these symptoms plus a fever, then
you and your health-care provider should think about other
possibilities, including strep throat, sinusitis, pneumonia or the flu. A
true fever often means something else is going on in your body."

5. Home remedies such as chicken soup don’t work. "In 2000, researchers at the University of Nebraska studied homemade chicken soup
and found that it had anti-inflammatory benefits, which can ease cold
symptoms," Frayha writes. "Chicken soup
exerted an anti-inflammatory effect — which could help a person feel
better faster." She cautions, "There are dozens of home remedies that are said to help speed up recovery: ginseng, zinc, vitamin C, neti pots. There is little evidence to support them; some can even be harmful (for example, some zinc formulations can lead to permanent loss of smell)."

Sunday, November 15, 2015

In his successful campaign for governor, Republican Matt Bevin said he would not continue to enroll in the Medicaid program people with incomes at 138 percent of the federal poverty level, the limit for the Medicaid expansion that Gov. Steve Beshear ordered under the federal health-reform law. But he will have to keep doing that in order to get the federal waiver he needs to reshape the program, health-law expert Sara Rosenbsum predicts in an online article for the Milbank Quarterly, a public-health journal.

Bevin has been "hinting that he might support retention of Medicaid for current
beneficiaries while capping or eliminating coverage for those who might
qualify for coverage in the future, Rosenbaum writes. "Medicaid is a legal entitlement,
however. This means that people who are eligible for coverage must be
allowed to enroll when they successfully apply. And because Medicaid is a
safety-net program, people who believe that they may qualify for
assistance must be allowed to apply for it when the need arises,
unconstrained by formal open enrollment periods or special enrollment
rules. As a result, despite the states’ broad discretion to shape their
Medicaid programs to meet their residents’ needs, Gov. Bevin, acting
on his own, cannot simply cap enrollment.''

Sara Rosenbaum, Ph.D.

Rosenbaum notes that in its 2012 decision upholding almost all of the Patient Protection and Affordable Care Act, the U.S. Supreme Court "emphasized that the secretary of health and human services retains full power to enforce the terms of the Medicaid expansion
even if it is, effectively, optional. Moreover, HHS has made clear that
the expansion under the ACA retains Medicaid’s full entitlement
criteria, thereby barring states from imposing artificial limits on
coverage."

None of the seven states operating Medicaid programs under a federal waiver (Arkansas, Montana, Iowa, Michigan, New Hampshire, Indiana and Pennsylvania) "uses enrollment caps. Simply put, capping enrollment is a nonstarter," Rosenbaum writes. (Bevin and state Senate President Robert Stivers have said they are looking to Indiana's program as a possible model for Kentucky.)

Also, "No other Republican governor elected in an expansion state with
expanded Medicaid coverage has chosen to eliminate benefits; indeed,
nearly a dozen Republican governors have embraced the expansion," Rosenbaum notes. "One
reason may be that, as the Kaiser Family Foundation reports, more than
half of Republican voters in non-expansion states favor expansion."

In seeking a waiver, the Bevin administration will start "an intricate, closely watched dance between Kentucky and the Obama administration," Rosenbaum writes. How will it play out? "No one should bet on life and health," she cautions. "But if one were to do so, the
odds are that HHS will stand firm, Gov. Bevin will blink, and
Medicaid coverage in Kentucky will prevail. To bet otherwise would be
politically inadvisable and, more important, morally unacceptable."

Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy in the Milken Institute School of Public Health at George Washington University in Washington, D.C.

Thursday, Nov. 19, is the Great American Smokeout, a day when smokers are encouraged to quit for the day and make a plan to quit for good. That remains important in Kentucky, which has the highest rates of lung cancer and deaths from it, and where more than one in four adults smoke, the second highest rate in the nation.

Every third Thursday since 1976, the American Cancer Society has coordinated the Smokeout. It has helped change Americans’ attitudes about smoking, and probably saved millions of lives.

While national smoking rates have dropped dramatically, from about 42 percent of adults in 1965 to
about 18 percent, about 42 million adults still smoke cigarettes, and
tobacco remains a major killer, responsible for nearly one in five
deaths in the United States, and at least 30 percent of all cancer deaths, the ACS says. (For a statistical profile of U.S. smokers, from The Washington Post, click here.)

Today, smokers have more tools than
ever to help quit smoking, but it remains one of the strongest
addictions known. Smokers often have to make several quit attempts,
using any of several tools, some proven, some not, before they find
the method that works for them. Among those tools smokers can consider:

• Nicotine replacement therapy

• Telephone and online based
support and counseling

• Quit smoking programs and
support groups

• Prescription drugs

Studies show 70 percent of smokers want to
quit. Here's a timeline of the benefits of quitting:

Armed with data and an unusual dose of emotion, outgoing Gov. Steve Beshear urged Gov.-elect Matt Bevin to reconsider his positions and keep the state's Medicaid expansion and insurance exchange during a Friday news conference at the Capitol.

His voice cracking, Beshear said, "For the health of our families, the future of this state, we cannot throw away the progress we have made and start over, just to make a political point. This is not about President Obama. This is not about Steve Beshear. It is about the people of Kentucky, improving their health, improving a stronger workforce, growing our economy."

Bevin said during his campaign and his post-election news conference that he would dismantle the Kynect exchange and shift clients to the federal exchange because "It is a redundancy that we as taxpayers in this state are paying for twice." Kynect is funded by a 1 percent fee on all Kentucky health-insurance policies; the federal exchanges levies a 3.5 percent fee on its policies.

After first saying he would abolish the expansion of Medicaid to those with incomes up to 138 percent of the federal poverty line, which covers 400,000 people, Bevin has said he plans to apply for a federal waiver to require clients to have some "skin in the game" through premiums, co-payments, deductibles or health savings accounts. He has suggested that the income limit could be lowered, but no state has been allowed to do that.

Beshear said, “During election season the political rhetoric tends to be strong and the promises bold. But the fun and games are over, and it is time to get serious.”

In his plea for Bevin to reconsider, Beshear said there are only two factors to consider about the health reforms in Kentucky: are they working and can we afford them? He and Lt. Gov. Crit Luallen said they are working, and the state can afford it: "That answer is just as clear and just as definite, provided you put unsupported opinion and ideology aside and look at facts and figures."

Beshear said getting rid of Kynect, which has been called a national model, makes "no sense." He said, "It is inconceivable to me why, just to make a partisan political statement, Kentucky would want to go backward and become the first state to decommission a successful exchange. . . . It would be stupid to turn our backs on it because it would lose us money."

He said moving to the federal exchange would waste the $283 million in federal grants used to create Kynect; would cost at least $23 million in Kentucky tax funds to dismantle it; would take away Kentucky's oversight; would add months of delay and duplication to the process; and would get rid of the locally responsive Kynectors, located in every county, and replace them with a customer service team that is located "hundreds of miles away." He said health-care providers, insurance companies and other business interests (including the Kentucky Chamber of Commerce) want to keep Kynect.

On Medicaid, Beshear said a waiver wouldn't have much effect on the program's costs, and said there is another side to the "skin in the game" argument.

“If I’m only making $30,000 a year and I’m supporting a
family of four and everybody’s well right now and I can take $30 a month
or $50 a month that I would have to pay in in order to be covered here
and use it to feed my family or buy the textbooks that our kids need to
go to school, people are tempted to say, ‘Well, I really don’t need this
health care right now. I need this money to support my family’,” Beshear said.

The governor tried to contradict Bevin's assertion that the Medicaid expansion is "unsustainable." The federal government pays the full cost of the expansion through next year. In 2017, states will pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Beshear walked the audience through experts' estimates of how the expansion would more than pay for its estimated $257 million cost in the next two-year budget: $265 million in state General Fund savings for services that the federal government now covers under the expansion; $246.8 million in additional revenue from new jobs and taxes created by expanding the health industry; and $45.7 million in "restricted fund" revenue, from a new 1 percent assessment on Medicaid manage-care organization and insurance companies. He said the expansion will net the state $300 million that is sorely needed for other programs in the state.

Beshear cited the Deloitte Consulting study that used data from 2014, the first full year of the expansion. The report said the expansion created 12,000 jobs and generated at least $1.3 billion in payments to health-care providers, a number that has risen to $2.9 billion through July 2015. The study predicted the expansion would add $30 billion to Kentucky's economy and have a positive budget impact of $820 million over eight years for state and local governments, even after the state match for Medicaid cost is phased in, Beshear said.

Beshear said that by improving the health of Kentuckians, the expansion is also improving their quality of life, economic capacity, worker productivity, school attendance and even the state's public image.

"The more we improve our health and the more we improve our economy, the less we will need to rely on programs like Medicaid," he said. "This is a long-term plan for improving Kentucky, but you won't see it if you are blinded by short-term political ambitions or concerns."

He encouraged Bevin to look at other Republican governors, like Ohio Gov. John Kasich, who have gone against most of their party colleagues to expand Medicaid.

"At the end of the day, folks, we have to pull important policy decisions out of the vat of corrosive acid called partisan politics and we all have to answer for how we treat each other," he said, calling on Bevin to “look at this from a business standpoint, if not from a human standpoint.”

Beshear said he and Bevin have met privately once since Bevin was elected and had agreed to not publicly share details of the meeting, but did say that he encouraged Bevin and his aides to "just look at the facts" as well as what is best for the people of the state.

“My impression is that he’s willing to look at the data and look at the facts, and you know, he made no promises one way or another,” Beshear said. “But he’s a business guy and he’s used to looking at facts and figures and that’s what I would encourage him to do.” (For video clips of Beshear's press conference, from cn|2, click here.)

In reply, Bevin spokeswoman Jessica Ditto said, “Governor-Elect Bevin has laid out a health-care vision for Kentucky that will encourage personal responsibility and focus on expanding access to quality, affordable health care coverage. His administration will move forward in addressing Kentucky’s health-care needs in a deliberate and thoughtful fashion, consulting with Kentucky’s health-care stakeholders, his Cabinet appointees and the General Assembly.”

Republican Senate President Robert Stivers said in July that the legislature would decide the shape of the Medicaid expansion, and said after the election that his staff had consulted with its counterparts in Indiana about that state's expansion.

Sharing the stage with Beshear was Luallen, chairwoman of Kyhealthnow, a program Beshear created in 2014 to set seven major health goals and reach them by 2019. She said improving Kentuckians' health must remain a priority.

"On this issue, we simply cannot afford to go backward," Luallen said. "This is a once-in-a-lifetime opportunity to change the future of Kentucky. We have demonstrated that improving the health of our people is affordable. It's time to move the discussion from saving money to saving lives."

Gov.-elect Matt Bevin vowed to scale back the state's Medicaid expansion, but that didn't seem to hurt him much in counties with a high percentage of Medicaid recipients, as they voted strongly for the Republican, Transylvania University political scientist Andrea Malji found.

"The larger the Medicaid numbers, the more likely they were to
back Bevin," John Cheves reports for the Lexington Herald-Leader. "The lower the Medicaid numbers, the more likely
they were to favor the Democratic nominee, Attorney General Jack Conway. . . . This was true even in traditional Democratic Party strongholds, such as Pike and Breathitt counties."

In Malji's native Pulaski County, a Republican stronghold where Bevin got 72 percent of the vote, she heard people "denounce 'Obamacare' while thousands rushed to sign up with Kynect," the state exchange where people can sign up for Medicaid or buy subsidized insurance policies, Cheves writes. "They didn't
seem to realize that Kynect, Kentucky's response to the federal Patient
Protection and Affordable Care Act, is the same thing as Obamacare, she
said."

Majli told Cheves, "There's either voter disconnect here, where the people
weren't thinking about or weren't aware of Bevin's stance on health
care, or these counties just have higher levels of social conservatives
who thought it was more important to vote on social issues."

In smaller but even more Republican Owsley County, 70 percent of the voters chose Bevin though 66 percent are on Medicaid. Democratic Judge-Executive Cale Turner "said the
election results didn't surprise him," Cheves reports/ "His constituents wanted to express
their opposition to Democratic President Barack Obama and what they
perceive as 'the liberal agenda' on social issues, Turner said..

Turner told Cheves, "A lot of folks in Owsley County went to the polls
and voted against gay marriage and abortion, and as a result, I'm afraid
they voted away their health insurance -- which was their
right to do, I guess. But it's sad. Many people here signed up with
Kynect, and it's helped them, it's been an absolute blessing."

Lisa Botner, 36, told Cheves that she recently got a Medicaid card for herself and her 7-year-old son so she can get doctor visits and blood
tests for her hyperthyroidism, but voted for Bevin because "I'm just a die-hard Republican."

The annual Kentucky Kids Count report on the well-being of the state's children says that we lead the nation in smoking by pregnant mothers, that one in four Kentucky children live in poverty, and that nearly half or more of Kentucky's eighth and fourth graders aren't proficient in math or reading, respectively.

“Governors and the Kentucky General Assembly made significant strides in policies to help kids over the last quarter century, such as the Kentucky Education Reform Act, juvenile justice reform, and ensuring more children have health insurance,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. “But we still face dire challenges. . . .We have a long way to go to get Kentucky where it needs to be for children."

The report, released Sunday by KYA, is part of the 25th annual release of the County Data Book, which ranks all Kentucky counties on overall child well-being based on 16 indicators, or points of measurement, in four domains: economic security, education, health, and family and community strength.

Overall Child Well-Being by County, by ranking groups

The report notes that some of the indicators included in the 2015 rankings are different than those included in previous Data Books, so current rankings should not be compared to previous rankings.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Edmonson, and Calloway counties. Owsley, Wolfe, Martin, Breathitt, and Clay counties scored at the bottom of the list.

Health

"Health impacts every aspect of a child's life and is one of the most important components of overall child well-being," says the report.

One of the measures of health in the report is smoking during pregnancy. In Kentucky, county rates varied widely for this measure, from less than 14 percent in Fayette, Jefferson, and Oldham Counties, to 40 percent or more in Clay, Elliott, Lee, Owsley, and Robertson Counties.

"Smoking during pregnancy contributes to low-birth-weight and preterm births. In 2011-13, more than one in five (22.5 percent) Kentucky babies were born to mothers who smoked during pregnancy, which is the highest rate in the nation," says the release.

All graphics from Kids Count report

Other poor health indicators include: 8.7 percent of Kentucky babies are born with low weight, and many are the result of teen pregnancies: 40.6 of every 1,000 Kentucky females age 15-19 gave birth in 2011-13.

The number of teen births varies widely in Kentucky, from fewer than 22 per 1,000 in Calloway, Oldham, Rowan and Woodford counties to more than 80 per 1,000 in Fulton, McCreary, Magoffin, Powell and Wolfe.

The report offers these solutions to improve the health of Kentucky's children: making sure Kentucky families and their children have health coverage, reducing maternal smoking during pregnancy by enacting a statewide smoking ban, and increasing families' resources to purchase healthy foods by doubling food-stamp benefits for fruits and vegetables, including from farmers' markets.

Family and community

More broadly, the report says solutions to improve the well-being of Kentucky's children must involve a two-generational approach.

"Parental well-being is critical to children's success; conversely, parents' ability to succeed in education and employment is affected by how well their children are doing," says the report.

In 2009-13, nearly one in six births were to women without a high-school diploma, and 32 percent of Kentucky's children lived in a single-parent family.

In 2012-14, 3.75 percent of children aged 10-17 were in the juvenile justice system. The counties with the smallest percentages of children in the system were Oldham (0.36), Henry (0.62) and Washington (0.77). Those with the highest were Owsley (9.6), Christian (8.9), Grayson (8.9) and Powell (8.6).

"When kids mess up, it is important to hold them accountable in a way that is appropriate for their age and development and help them get back on track for success," says the release.

Economic security
One of the well-being indicators measured in the report is economic security, which "refers to a family's ability to meet its needs in a way that promotes the health and well-being of parents and addresses the physical, emotional and educational needs of children," says the report.

"The single most important inhibitor to a child’s success is poverty," says the release. "Poverty impacts children’s ability to learn in school, to be healthy, and to succeed as adults."

The report says Kentucky’s child poverty rate in 2009-13 was 26 percent, but several counties fared much worse. In Martin, Lee, and Wolfe counties, more than half the children lived in poverty; in Carroll, Jackson, Knox and Clay counties, the rate was near 50 percent.

The report makes several suggestions to increase children's economic security, including: increasing employment opportunities for their parents; offering technical or educational training; expanding the Child Care Assistance Program to 200 percent of the federal poverty level; and enacting an earned-income credit for state taxes, which would allow poor families to keep more of their income.Education

Another indicator measured in the report is education, which will determine the quality of Kentucky's future workforce, says the report.

Kentucky continues to struggle in this area, with 50 percent of its kindergartners rated not ready to learn; 48 percent of its fourth graders not proficient in reading; 56 percent of its eighth graders not proficient in math; and 12 percent of its high school students not graduating on time.

Leslie County was the only Kentucky county that graduated all its students on time in 2014-15, while Franklin, Jefferson, and Breathitt counties had the lowest rates of on-time graduation.

In 12 of Kentucky's 120 counties, 70 percent or more of eighth graders are considered not proficient in math. "Math proficiency in eighth grade is a key indicator of a child's readiness for higher education," says the report.

Proficiency in reading is an indicator of on-time graduation, according to the report. About 75 percent of fourth-graders were rated not proficient in Breathitt, Robertson and Owsley counties; Calloway and Morgan counties ranked best, with the lowest such percentage.

Half of incoming kindergartners in Kentucky are not prepared for school. "Children who start formal education with strong school readiness skills tend to maintain that advantage throughout their elementary school years," the report says. In other words, it's hard to catch up.

A few of the report's recommendations to improve education include expanding access to early-childhood education by increasing pre-school eligibility levels, and reforming system-wide funding and accountability in Kentucky's juvenile justice, child welfare and behavioral health residential settings.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!